Refund Application Form

I'm applying for *

Refund of Tuition/Amenities fees
Refund of other fees

Refund reason *

Course/Class/Module cancelled by Melbourne Polytechnic
Partial withdrawal prior to or within 28 days of confirmed start date of course or re-enrolment commencement date
Full withdrawal prior to or within 28 days of confirmed start date of course or re-enrolment commencement date
Health Care Card reimbursement
I'm an employer or third-party who has paid the fees on behalf of an apprentice, trainee or student
Other

Your name *

Company name *

Cessation of employment or third-party services date *

Will the student remain enrolled? *

Yes
No
Unsure

What is the reason for refund? *

Refunds Application Form

Section A: Student Details